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Exchange enrollments at 3.3 million, big jump in January


By Paul Demko
Posted: February 12, 2014 - 5:15 pm ET
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(Story updated at 6:15 p.m. ET)

Nearly 3.3 million individuals signed up for private insurance plans through the state and federal exchanges during the first four months of the open enrollment period, HHS reported Wednesday. The total represents significant growth in January, but is still less than halfway toward the goal of 7 million enrollments by March 31.

State exchanges enrolled 1.4 million individuals through the end of January, while 1.9 million individuals signed up through the federal exchange, according to figures released by the CMS on Wednesday. The federal exchange, in particular, showed momentum in January: Nearly 40% of total enrollments through the federal HealthCare.gov website occurred last month.

“It's very, very encouraging news,” HHS Secreatary Kathleen Sebelius said on a call with reporters Wednesday.

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The latest numbers showed a slight improvement in the age demographics for exchange enrollments, an important metric. Of those signing up for coverage in January, 27% were between the ages of 18 and 34. That's up from 24% during the first three months of exchange operations. Most experts say that number will need to be closer to 40% to create a balanced, sustainable risk pool.

“We're seeing a growing population of Americans who are young, healthy and well covered, and these younger Americans are signing up in greater proportions,” Sebelius said.

However, in some states exchange customers continue to skew significantly older. In Ohio and Wisconsin, for example, only 21% of enrollees were between the ages of 18 and 34.

A gender discrepancy is also emerging, with women representing 55% of those seeking coverage. In some states, the gender imbalance is even more pronounced. Women account for 60% of signups in Oregon and 62% of exchange customers in Mississippi.

Ceci Connolly, managing director of PwC's Health Research Institute, isn't surprised by that development. “We know that overwhelmingly in American households the women make many of the shopping choices, and absolutely the healthcare shopping choices,” Connolly said. “They just have been playing that role in our society for a long time.”

HHS also issued data for the first time on the type of plans being purchased on the exchanges. More than 60% of state and federal exchange customers opted for silver plans, which are designed to cover 70% of medical costs.

Connolly points out that in order to qualify for subsidies consumers must purchase a plan with coverage equal to at least a silver plan. “In the vast majority of cases the smarter move, the better deal, is silver or up,” Connolly said. “That message is getting through and they're taking advantage of the subsidies.”

There is still no data available on how many individuals have actually made their first premium payment. That means that some of the people who signed up for a plan may not actually have insurance coverage because they failed to pay. In addition, HHS has not released any breakdown of how many people signing up for coverage through the exchanges were previously uninsured.

More than 80% of individuals selecting plans through the state and federal marketplaces through January were eligible for federal subsidies. Those with income up to 400% of the federal poverty level—roughly $46,000 for a single adult—qualify for assistance. The Patient Protection and Affordable Care Act requires most Americans to obtain coverage by March 31 or incur a financial penalty of $95 or 1% of their income, whichever is greater.

Last week, the Congressional Budget Office reduced its estimate for how many people will sign up for coverage in 2014 from 7 million to 6 million, due in part to the rocky rollout of the federal exchange and continued problems with some state marketplaces.

Follow Paul Demko on Twitter: @MHpdemko


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